1000例老年住院患者抗菌药物使用的调查分析

目的调查和分析我院60岁以上老年住院患者抗菌药物的使用情况和存在问题,以提高临床使用抗菌药物的合理性。方法采用随机抽样的方法,回顾性地调查我院2008年1-12月60岁以上老年住院患者抗菌药物的使用情况,包括：抗菌药物应用及联合应用、抗菌药物使用途径及目的、感染部位、主要病原菌、主要病原菌对抗菌药物耐药率以及肝、肾功能不全患者用药等。结果共调查1 000份老年患者出院病历,抗菌药物的使用率为61.10%,感染率为47.90%;联合用药占49.42%,治疗性用药占71.36%,以静脉给药为主（占86.94%）,应用抗菌药物,前三位分别为头孢菌素类34.67%,喹诺酮类23.11%,青霉素类19.94%。主要的感染部位是：呼吸系统60.98%,泌尿系统18.16%,消化系统12.52%。感染的病原菌以革兰阴性杆菌为主,主要为大肠埃希菌31.14%,铜绿假单胞菌22.75%,鲍曼不动杆菌15.57%。革兰阳性球菌对红霉素、青霉素、环丙沙星耐药率高（〉50%）,对万古霉素无耐药;革兰阴性杆菌对亚胺培南、阿米卡星耐药率较低。合理使用抗菌药物占85.11%;根据患者肝、肾功能不全而调整给药剂量的占80.87%。结论我院老年患者抗菌药物使用存在不合理性,提示临床工作中必须重视老年患者抗菌药物的合理使用。     

2013年住院患者抗菌药物使用调查

目的：调查研究本院住院患者的抗菌药物应用情况,为促进抗菌药物临床合理应用提供参考。方法临床药学室每月随机抽取出院病历180~230份进行医嘱点评,2013年抽取出院病历2520份,对其中使用抗菌药物的病历根据各项法律法规统计分析评价。结果在抽取的2520份病历中,使用抗菌药物的病历有640份（25.39%）。抗菌药物使用合理450/640份（70.31%）;不合理190/640份（29.69%）。不合理应用情况：给药频次不当、预防给药时机不合理、联用不合理、换药无指征等。结论我院抗菌药物使用基本规范,但仍然存在部分不合理现象,仍需加强抗菌药物相关知识法规培训,提高合理用药水平。     

153例老年住院患者抗菌药物使用分析

目的了解我院老年住院患者常见病原菌及其耐药情况以及临床抗菌药物的应用情况，促进抗菌药物合理应用。方法随机抽取我院2005年60岁以上有感染指征的住院患者病历153份做统计分析。结果153例中76例送检分离的主要病原菌为：大肠埃希菌（25％）、铜绿假单胞菌（18．8％）、表葡菌（11．5％）、金葡菌（9．4％）和肺炎克雷伯菌（7．3％）；铜绿假单胞菌对常用的10种抗菌药物耐药率高。结论老年患者临床应用抗菌药物仍存在问题，应加强对临床致病菌的分离检验，增加药敏试验中抗菌药物类别和品种，建立并完善抗菌药物临床应用规范和制度，有待临床医师、检验师和临床药师的共同参与。     

242例I类切口手术围术期预防性应用抗菌药物合理性分析

目的：了解某院I类切口手术围术期预防性应用抗菌药物情况,为临床合理用药提供参考。方法：调取2011年1月1日_2011年12月31日某院住院期间所有行甲状腺切除术、乳腺切除术、腹股沟疝修补术的患者病历,排除术前已存在感染并已开始使用抗感染药的患者及有其他复杂基础疾病致住院20d以上者,对纳入病例的抗茵药物使用情况进行评价、分析。结果：共有242例符合要求,所有患者均使用了抗菌药物。单一使用第1、2代头孢菌素类者89例（占36．6％）;二联和三联用药者72例（占29．75％）。非术前2h内给药者8例（占3．3％）;停药时间超过术后48h者158例（占65．3％）;平均用药时间为4．3d。结论：I类切口手术预防性应用抗茵药物存在不合理现象,需加强抗菌药物管理。     

5636例住院患者抗菌药物使用及其不合理用药实例分析

目的：分析广西医科大学第四附属医院住院患者抗菌药物的应用情况及其不合理用药实例。方法：随机抽取2012年1—12月间住院患者病历,对其使用抗菌药物的情况进行分析。结果：抽取的7920份病历中使用抗菌药物者为71．16％（5636例）,不合理用药者为2．73％（216例）占使用抗菌药物百分比为3．83％;不合理用药主要表现在预防用药选择不当及术后预防用药时间过长等方面。结论：内科系统抗菌药物的使用基本合理,而外科系统预防性使用抗菌药物存在诸多不合理现象,应加强预防性使用抗菌药物相关知识的培训和行政干预,进一步规范抗菌药物的使用。     

老年住院患者抗菌药物使用分析

目的了解老年住院患者抗菌药物使用情况。方法随机抽取我院2002年至2007年住院患者病例61份,调查分析其抗菌药物使用情况。结果抗菌药物使用率96.72%,应用最多的是头孢菌素和喹诺酮类。结论老年人抗菌药物的使用基本安全、有效,但存在不合理之处,亟待解决。     

我院住院患者抗菌药物应用分析

目的：分析我院住院患者抗菌药物的使用情况,为开展抗菌药物专项整治活动提供依据,促进抗菌药物的合理应用。方法：利用计算机网络系统收集2009-2011年我院院患者抗菌药物使用的数据资料,采用Excel 2003对各项数据进行汇总,计算抗菌药物的用药频度（DDDs）、累计 DDDs 及抗菌药物使用强度（antibacterial use density , AUD）并进行分析。结果：2009-2011年我院 AUD 分别为每百人天86.60,88.40,62.10限定日剂量（DDD）。 DDDs排序前10位的抗菌药物中,头孢菌素占主体地位,且限制使用级抗菌药物占90%,抗菌药物限定日费用（DDC）值偏高。结论：我院抗菌药物使用存在用药过度、用药集中、抗菌药物 DDC偏高等不合理问题,需进一步加强监督管理。     

我院住院患者抗菌药物使用分析

目的了解住院患者抗菌药物使用情况,促进临床合理用药。方法抽取2009年4月1日至6月30日使用抗菌药物的病历300份,对抗菌药物使用情况进行调查分析。结果不合理应用抗菌药物32例（10.67%）,包括预防用药时间过长等。结论住院患者抗菌药物使用存在较多不合理现象,应加强管理,以保证患者用药安全。     

老年患者与非老年患者Ⅰ类切口手术预防应用抗菌药物对比分析

随机抽取我院2011年出院的接受清洁切口手术患者200例,对比分析老年患者(100例)与非老年患者(100例)围手术期预防应用抗菌药物的使用情况。结果发现老年患者与非老年患者只在手术时间和住院时间方面的差异有统计学意义,在药物选择、给药时机和用药疗程方面均无显著性差异,且存在较多不合理现象,应加强监管力度,促进抗菌药物合理应用。     

老年住院患者抗菌药物合理应用的综合干预效果分析

目的：考察分析我院老年住院患者实行抗菌药物综合干预后的变化及效果。方法：调取我院信息系统数据,采用抗菌药物分级管理分类系统,统计分析2013年1月至2015年12月在我院住院的老年患者抗菌药物使用金额、使用强度（AUD）及使用频度（DDDs）等数据。结果：通过3年的综合干预,老年住院患者抗菌药使用金额及使用强度明显下降;限制使用级抗菌药物金额比例逐年下降,特殊使用级抗菌药物金额比例呈增加趋势;注射用头孢米诺钠连续3年DDDs排名第一,头孢呋辛酯片DDDs排名上升明显。结论：通过3年的专项整治及综合干预,老年住院患者抗菌药物应用变化显著,不合理使用得到有效控制,各项用药指标逐步趋于合理规范。     

Synthesis,Cytotoxicity and Antileishmanial Activity of Some N-(2-(indol-3-yl)ethyl)-7-chloroquinolin-4-amines

We report herein the condensation of 4,7-dichloroquinoline (1) with tryptamine (2) and D-tryptophan methyl ester (3) . Hydrolysis of the methyl ester adduct (5) yielded the free acid (6) . The compounds were evaluated in vitro for activity against four different species of Leishmania promastigote forms and for cytotoxic activity against Kb and Vero cells. Compound (5) showed good activity against the Leishmania species tested, while all three compounds displayed moderate activity in both Kb and Vero cells.     

Lung disease and PKCs

The lung offers a rich opportunity for development of therapeutic strategies focused on isozymes of protein kinase C (PKCs). PKCs are important in many cellular responses in the lung, and existing therapies for pulmonary disorders are inadequate. The lung poses unique challenges as it interfaces with air and blood, contains a pulmonary and systemic circulation, and consists of many cell types. Key structures are bronchial and pulmonary vessels, branching airways, and distal air sacs defined by alveolar walls containing capillaries and interstitial space. The cellular composition of each vessel, airway, and alveolar wall is heterogeneous. Injurious environmental stimuli signal through PKCs and cause a variety of disorders. Edema formation and pulmonary hypertension (PHTN) result from derangements in endothelial, smooth muscle (SM), and/or adventitial fibroblast cell phenotype. Asthma, chronic obstructive pulmonary disease (COPD), and lung cancer are characterized by distinctive pathological changes in airway epithelial, SM, and mucous-generating cells. Acute and chronic pneumonitis and fibrosis occur in the alveolar space and interstitium with type 2 pneumocytes and interstitial fibroblasts/myofibroblasts playing a prominent role. At each site, inflammatory, immune, and vascular progenitor cells contribute to the injury and repair process. Many strategies have been used to investigate PKCs in lung injury. Isolated organ preparations and whole animal studies are powerful approaches especially when genetically engineered mice are used. More analysis of PKC isozymes in normal and diseased human lung tissue and cells is needed to complement this work. Since opposing or counter-regulatory effects of selected PKCs in the same cell or tissue have been found, it may be desirable to target more than one PKC isozyme and potentially in different directions. Because multiple signaling pathways contribute to the key cellular responses important in lung biology, therapeutic strategies targeting PKCs may be more effective if combined with inhibitors of other pathways for additive or synergistic effect. Mechanisms that regulate PKC activity, including phosphorylation and interaction with isozyme-specific binding proteins, are also potential therapeutic targets. Key isotypes of PKC involved in lung pathophysiology are summarized and current and evolving therapeutic approaches to target them are identified.     

Gender-related symptoms and correlates of alcohol dependence among men and women with a lifetime diagnosis of alcohol use disorders

This study explored gender-related symptoms and correlates of alcohol dependence in a crosssectional study of 150 men and 150 women with a lifetime diagnosis of alcohol use disorders (AUD). Participants were recruited in equal numbers from treatment settings, correctional centres and the general community. Standardized measures were used to determine participants' use of substances, history of psychiatric disorders and psychosocial stress, their sensation seeking and family history of substance use and mental health disorders. Multivariate analyses were used to detect patterns of variables associated with gender and the lifetime severity of AUD. Men had a longer history of severe AUD than women. Women had similar levels of alcohol dependence and medical and psychological sequelae as men, despite 6 fewer years of AUD. More women than men had a history of severe psychosocial stress, severe dependence on other substances and antecedent mental health problems, especially mood and anxiety disorders. There were differences in family history of alcohol-related problems approximating same-gender aggregation. The severity of a lifetime AUD was predicted by its earlier age at onset and the occurrence of other disorders, especially anxiety, among both men and women. The limitations in the generalizability of these findings due to sample idiosyncrasies are discussed.     

Biochemical and molecular characterisation of cubozoan protein toxins

Class Cubozoa includes several species of box jellyfish that are harmful to humans. The venoms of box jellyfish are stored and discharged by nematocysts and contain a variety of bioactive proteins that are cytolytic, cytotoxic, inflammatory or lethal. Although cubozoan venoms generally share similar biological activities, the diverse range and severity of effects caused by different species indicate that their venoms vary in protein composition, activity and potency. To date, few individual venom proteins have been thoroughly characterised, however, accumulating evidence suggests that cubozoan jellyfish produce at least one group of homologous bioactive proteins that are labile, basic, haemolytic and similar in molecular mass (42-46 kDa). The novel box jellyfish toxins are also potentially lethal and the cause of cutaneous pain, inflammation and necrosis, similar to that observed in envenomed humans. Secondary structure analysis and remote protein homology predictions suggest that the box jellyfish toxins may act as α-pore-forming toxins. However, more research is required to elucidate their structures and investigate their mechanism(s) of action. The biological, biochemical and molecular characteristics of cubozoan venoms and their bioactive protein components are reviewed, with particular focus on cubozoan cytolysins and the newly emerging family of box jellyfish toxins.     

Dose tolerability of chronically inhaled voriconazole solution in rodents

Invasive pulmonary aspergillosis (IPA) is a fungal disease of the lung associated with high mortality rates in immunosuppressed patients despite treatment. Targeted drug delivery of aqueous voriconazole solutions has been shown in previous studies to produce high tissue and plasma drug concentrations as well as improved survival in a murine model of IPA. In the present study, rats were exposed to 20 min nebulizations of normal saline (control group) or aerosolized aqueous solutions of voriconazole at 15.625 mg (low dose group) or 31.25 mg (high dose group). Peak voriconazole concentrations in rat lung tissue and plasma after 3 days of twice daily dosing in the high dose group were 0.85 ± 0.63 μg/g wet lung weight and 0.58 ± 0.30 μg/mL, with low dose group lung and plasma concentrations of 0.38 ± 0.01 μg/g wet lung weight and 0.09 ± 0.06 μg/mL, respectively. Trough plasma concentrations were low but demonstrated some drug accumulation over 21 days of inhaled voriconazole administered twice daily. Following multiple inhaled doses, statistically significant but clinically irrelevant abnormalities in laboratory values were observed. Histopathology also revealed an increase in the number of alveolar macrophages but without inflammation or ulceration of the airway, interstitial changes, or edema. Inhaled voriconazole was well tolerated in a rat model of drug inhalation.